It is important that the limitations of this study be identified so that findings can be interpreted correctly within the context of the study and future studies can improve on these.
It may be argued that the objective function of health facilities should be to maximize health gains using available resources. Therefore, the ideal output is expected to capture both quantity and quality of lives of those who interact with hospitals. However, data on either Disability- Adjusted Life Expectancy (DALE) or Quality-Adjusted Life Year (QUALY) gained due to health care in each hospital are not available. Consequently, we use proxies that had been used in similar studies.
The present study could not determine inefficiency due to systematic quality variations though there may be variations in the quality of care provided in each hospital. Due to the quality of data keeping system in most of the health systems in Nigeria, we were not able to obtain data that would have been useful in defining quality-adjusted outputs. Indeed, the study was limited to two states in South West Nigeria on the account that complete data could not be obtained for other states after several trials. In other states visited, the data were kept in a format that limits their usefulness for the present study.
In addition, ministry staff were not forthcoming in their responses to the questionnaire administered to unpack the factors affecting hospital performances. It was decided to leave some of the questionnaires that could not be retrieved after reasonable trials, however, a common thread seem to exist in the responses retrieved as reported in the study.
Another main limitation of the study is the concentration of our efforts on public hospitals and secondary care facilities. Future research efforts are required to extend the study to include sole proprietorship, partnership and missions’ hospital, as well as primary care level facilities. Research efforts of this kind will provide empirical evidence for or against the hypothesis that both private and public facilities do not always use resources efficiently.
Furthermore, in the light of the problems of health financing, equity and efficiency confronting public and private sector, there is a need for technical and allocative efficiency
studies in public, private and mission hospitals with a view to identifying inefficiencies in individual hospitals and input profile. The present study excludes allocative efficiency due to inability to obtain reliable and complete data on input prices.
Finally, a DEA based malmquist productivity index analysis to monitor and evaluate changes in efficiency and those changes accounted for by technology, is required. This is not included in the study because of incomplete data for all those hospitals in the study.
References
Abramson J.H and Abramson Z.H (1999) Survey Methods in Community Medicine, London:
Churchill Livingstone
Adendorff, S.A, Botes, P. S; de Wit, P.W.C, van Loggerenberg, B.J and Steenkamp, R.J (1999) Production and Operations Management: A South African Perspective, Cape Town: Oxford University Press Southern Africa
Adeyemo, D.O (2005), Local Government Healthcare Delivery: A Case study, Journal of Human Ecology 18(2):149-160
Afonso.A and St. Aubyn M (2006) Relative Efficiency of Health Provision: A DEA Approach with Non-discretionary Inputs, Working Paper 2006/33, Dept of Economics, School of Economics and Management (ISEG), Technical University of Lisbon
Afzali, H. H (2007) Efficiency of Hospitals Owned by the Iranian Social Security Organisation: Measurement, and Remedial actions. Hospital PhD. Thesis University of Adelaide
Akazili, T; Adjuik, M, Jehu-Appiah, C and Zere, E (2008) Using DEA to Measure the Extent of Technical Efficiency of Public Health Centres in Ghana. BMC Health Services Research 8(11)
Akazili.J; Adjuik.M; Chatio.S; Kanyomse.E, Hodgson, A; Aikins.M and Gyapong.J (2008) What are the Technical Efficiency and Allocative Efficiencies of Public Health Centres in Ghana? Ghana Medical Journal 42(4):149-155
Akin, J.S, Birdsall N and de Ferranti (1987) Financing Health Services in Developing Countries: An Agenda for Reform Washington DC: World Bank Policy Study.
Alexander, J., Wheeler,A, Nahra,J R C and Lemark,C.H (1998), Managed Care and Technical Efficiency in Outpatient Substance Abuse Treatment Units, The Journal of Behavioural Health Services and Research, 25(4):377-396
Alvardo, J. R (2006) Evaluating Technical Efficiency of PHC in the Local Government of Chile, Autonimous University of Barcelona, juanrodrigo.alvarado@uab.es
Aminloo, H (1997) Prediction of Needed Hospital Beds in Molt and SSO, Tehran: Iranian Organisation for Planning Publication
Angrell, P and West, B (2001) A Caveat on the Measurement of Productive Efficiency, International Journal of Production Economics 69(1): 1-14
Asika, N (1991) Research Methodology in the Behavioural Sciences, Ikeja: Longman
Baggs.J.G; Ryan.S.A; Phelps.C.E; Richeson, J.F and Johnson.J.E (1992) Association between Interdisciplinary Collaboration and Patients Outcomes in Medical Intensive Care, Heart Lung, 21:18-24
Banjoko, S .A (2002) Production and Operations Mangement, Lagos: Pumark Nig. Limited Banker, R.D; Conrad, R.F and Strauss, R.P (1986) A Comparative Application of DEA and
Translog Methods: An Illustrative Study of Hospital Production, Management Science, 32(1): 30-34
Berndt, E.R; Friedlander, A.F and Chiang, J (1990) Interdependent Pricing and Mark- up Behaviour: An Empirical Analysis of General Motors, Ford and Chrysler, Working paper No 3396, Cambridge: National Bureau of Economic Research
Bhat, R; Verma, B.B and Reuben, E (2001) An Empirical Analysis of District Hospitals and Grant-in –aid Hospitals in Gujarat state of India, Ahmedabad: Indian Institute of Management
Bhat, R; Verma, B.B and Reuben, E (2001), Data Envelopment Analysis, Journal of Health Management, 3(2) pp 309-328.
Blank.J and Valdamanis.V (2001) A Modified three-stage DEA: An Application to Homes for the Mentally Disabled in Netherlands, Paper presented at the European workshop on efficiency and productivity analysis, Oviedo, Spain
Boyne, G.A (2002) Concepts and Indicators of Local Authority Performance: An Evaluation of the Statutory Frameworks in England & Wales, Public Money Management 22(2):
17-24
Bradford, D; Malt.R and Oates.W (1969) The Rising Cost of Local Public Services: Some Evidences and Reflection, National Tax Journal, 22(2):185-202
Bradford, W.D and Craycraft (1996) Prospective Payment and Hospital Efficiency, Review of Industrial Organisation 11:791-809
Button.K.J; Weyman-Jones.T.G (1992) Ownership Sructure, Institutional Organisation and Measured X-Efficiency, American Economic Review 82:439-445
Byrnes, P and Valdmanis, V (1993) Analysiing Technical and Allocative Efficiency of Hospitals in Charnes, A; Cooper, W.W, Lewin, A.Y and Seiford, L.M (eds) Data Envelopment Analysis: Theory, Methodology and Applications, Boston: Kluwer Cameron.K.S and Whetten.D.A (1983) Organisational Effectiveness: A Comparison of
Multiple Models, New York; Academic Press
Carmines.E.G and Zeller.R.A (1991) Reliability and Validity Assessment, Newbury Park:
Sage Publications
Chalos.P and Cherian.J (1995) An Application of DEA to Public Sector Performance Measurement and Accountability. Journal of Accounting and Public Policy, 14:143- 160
Chambers, R.G (1988) Applied Productivity Analysis: A Dual Approach, New York:
Cambridge University Press
Chang, H. H. (1998) Determinants of Hospital Efficiency: The Case of Central Government- Owned Hospitals in Taiwan. International Journal of Management Science 26(2) 307- 317
Charnes A; Cooper, W.W and Rhodes, E (1978), Measuring the Technical Efficiency of Decision Making Units, European Journal of operational research 2:429-444.
Chattopadhyay,S and Ray, S.C(1996) Technical, Scale and Size Efficiency in Nursing Home Care: A Nonparametric Analysis of Connecticut homes, Health Economics, 1(4): 303-373
Chen, Y. and Zhu, J. (2003) DEA models for Identifying Critical Performance Measures, Annual of Operations research, 124(1-4): 225-244.
Chiligerian, J.A (1993) Exploring why some Physician Hospital Practices are more Efficient: taking DEA inside the Hospital in Charnes.A; Cooper.W.W, Lewin.A.Y;
Seiford.L.M (eds) Theory, Methodology and applications, Boston: Kluwer Publishers Chiligerian.J A (1995) Evaluating Physician Efficiency in Hospitals: A Multivariate Analysis
of Best Practices, European Journal of Operations Research 80:548
Chilingerian, J; Sherman, D. H. (1997), DEA and Primary Care Physician Report Cards:
Deriving Preferred Practice Cares from Managed Care Service Concepts and Operating Strategies, Annals of Operations Research.
Chu.H.L; Liu, S. Z and Romels, J.C (2004) Does Capacitated Contracting Improve Efficiency? Evidence from California Hospital, Healthcare Management Review, 29(4) 344-352
Clewer, A and Perkin, D (1998), Economics for Health Care Management, London: Pearson Educational
Cochraine, A.L; Leger, A.S and Moore.F (1978)Health Service ‘Input’ and Mortality
‘Output’ in Developed Countries, Journal of Epidemiology and Community Health,32(3): 200-205
Coelli, T. J (1996) A Guide to DEAP version 2.1: A Data Envelopment Analysis Programme, CEPA working paper 96/8, Department of Econometrics, University of New England, Australia
Coelli, T.J; Prasada Rao, D.S; O’Donnell, C. J and Battesse, G.E (2005) An Introduction to Efficiency and Productivity Analysis, Second edition, New York: Springer Science Cole, G.A (1996) Management: Theory and Practice, 5th edition, London: Continuum
Cook.W.D and Zhu.J (2005) Modelling Performance Measurement: Applications and Implementations in DEA, Boston: Springer science+ Business Media Inc
Cooper.W.W; Seiford, L.M and Tone.K (2000) DEA: A Comprehensive Text with Models ,Applications, Reference and DEA Solver Software, Boston: Kluwer Academic Publishers
Coulam.R; Gaumer.G (1991) Medicare Prospective Payment: A Critical Appraisal, Health Care Fin. Per 13:45-77
Culyer A.J (199) The Morality of Efficiency in Health Care: Uncomfortable Implications, Health Economics 1(1):7-18
Daraio C and Simar L (2007), Advanced Robust and Non parametric Methods in Efficiency Analysis: Methodological and Applications, New York: Springer Science +
Dash U.; Vashnavi, S.D; Muraleedharan.V.R and Acharya, D. (2007) Benchmarking the Performance of Public Hospitals in Tamil Nadu: An Application of DEA, Journal of Health Management 9(1) 57-74
Davis, M.M; Aquilano, N.J and Chase, R.B (2003) Fundamentals of Operations Management, New York: McGraw-Hill Companies, Inc
Debreu G (1951), The Coefficient of Resource Utilization, Econometric 19, 273-292.
Delefice, L.C and Bradford, W.D (1997) Relative Inefficiencies in Production between Solos and Group Medical Practice Physicians, Health Economics 6:329-334
Denga, D I and Ali, A. (1998) An Introduction to Research Methods and Statistics in Education and Social Sciences, Calabar: Rapid Education.
Dorfman R; Samuelson, P Solow, R (1958), Linear Programming and Economic Analysis, McGraw Hill Text
Dorland, W.A (1981) Medical Dictonary 26th edition, Philadephia: W.B Sanders Company Dwivedi.D.N (1980) Managerial Economics, New Delhi: Vikas Publishing House PVT Dyson.R.G; Allen.R; Camanho.A.S; Podinovski.V; Sarrico, C.S and Shale.E.A (2001)
Pitfalls and Protocols in DEA, Journal of Operational Research 132:245-259
Eisenberg, J (1986) Doctors Decisions and the Cost of Medical Care, Ann Arbour: Health Administrations Press
El-Mahbary, Sand Lahdelma, R (1995) Data Envelopment Analysis: Visualising the Results.
European Journal of the Operational Research Society, 83(3):700-710
Epstein.P (1992) Get ready: the time for performance measurement is finally coming. Public Administration Review 52:513-519
Ersoy.K; Kuvuncubasi, S; Ozcan.Y and Harris, J.M (1997) Technical Efficiencies of Turkish Hospitals: Data Envelopment Analysis approach. Journal of Medical System.21:61-75 Fare, R; Grosskopf, S and Lovel.C.K (1994) Production Frontier, Cambridge: Cambridge
University Press
Farrel, M.J (1957), The Measurement of the Productive Efficiency Journal of the Royal Statistical Society, services A CXX, Part 3 253-290.
Federal Ministry of Health (1998) Health Planning and Management (students’ manual), Abuja: Department of Planning, Research and Statistics, FMoH
Federal Ministry of Health (2000) Health Sector Reform: Medium Term Plan ofAaction 2000-2002
Ferrari, A. (2006) Market Oriented Reform of Health Services: A Non-Parametric Analysis;
The Service Industry Journal 26(1) 1-13
Fetter, R.B (1991) Diagnosis Related Groups: Their Design and Development, Michigan:
Health Administration Press
Filippini, M; Farsi.M; Crivelli, L and Zola.M (2004) An Analysis of Efficiency and Productivity in Swiss Hospitals, Swiss Federal Statistics Office and Swiss Federal Office for Social Security
Filmer.D and Pritchett.L (1999) The Impact of Public Spending on Health: Does Money Matter? Social Science and Medicine, 49(10):1309-1323
Fizel, J.L and Nunnikhoven, T.S (1992) Technical Efficiency of For-profit and Non-profit Nursing Homes, Managerial and Decision Economics 13(5):429-439
Frank. R.H (1997) Micreconomics and Behaviour, 2nd edition, McGraw Hill Inc
Fried, H.O; Schmidt, S and Yaisawarng.S (1999) Incorporating the Operating Environment into a Non-parametric Measure of Technical Efficiency, Journal of Productivity Analysis, 12(3:249-267)
Galagedera.D.U.A and Silvapulle.P (2003) Experimental Evidence on Robustness of DEA Analysis, Journal of Operational Research Society 54:654-660
Garcia, F; Marcuello, C; Serrano, D. and Urbina, O. (1999), Evaluation of Efficiency in Primary Health Care Centres: An Application of Data Envelopment Analysis, Journal of Financial Accountability and Management, 15 (1)
Gathon, H. J and Perelman, S (1992) Measuring Technical Efficiency in European Railways:
A Panel Data Approach, Journal of Productivity Analysis 3(1): 135-151
Ghobadian, A and Asworth, J(1994) Performance Measurement in Local Government:
Concepts and Practice, International Journal of Operations and Production Management, 14(5): 35-51
Gonzales- Lopez.B and Barber –Parez, P (1996) Changes of the Efficiency of Spanish Public Hospital after the Introduction of Programme Contracts, Investment Economics, 20:377-402
Goodman.P.S and Penning.J.M (1997) Perspectives and Issues: An Introduction in J.M penning and P.S Goodman (Eds) New Perspectives in Organisation Effectiveness, San Francisco: Jossey Bassey
Grosskopf, S.D and Valdmanis, V.G (1987) Measuring Hospital Performance: A Non- Parametric Approach, Journal of Health Economics, 6(2):89-107
Gruca.T and Nath, D (2001), The Technical Efficiency of Hospitals under a Single Payer System: The Case of Ontario Community Hospitals, Health Care Management Sciences, 4: 91-101
Gujarati.N (2003) Basic econometric, Irwin: McGraw Hill
Harrision, J.P , Coppola,M.N and Wakefield, N(2004) Efficiency of Federal Hospitals in the United States, Journal of Medical System, 28(5);411-422
Health System Resource Centre (2004) County Health System briefing paper, Department for International Development (DFID)
Hofler, R.A and Rungeling, B (1994), US Nursing Homes: Are they Cost Efficient?
Economics Letters, 44 (3) 301-305
Hollingsworth, B(2003) Non-Parametric and Parametric Applications Measuring Efficiency in Health Care, Health Care Management Science, 6(4):203-218
Hollingsworth, B, Dawson, P and Maniadkis, N (1999) Efficiency Measurement in Health Care: A Review of Non-parametric Methods and Application, Health Care Management Science, 2(3):161-172
Hollingworth.B and Street, A (2006) The Market for Efficiency Analysis of Health Care Organisations, Health Economics 15:1055-105
Huang, Y. G. and McLanghlin, C. P. (1989), Relative Efficiency in Rural Primary Health Care: An Application of Data Envelopment Analysis, Health Services Research.
24:143-158
Imaga, E U L (2003) Theory and Practice of Production and Operations Management, 3rd edition, Enugu: Rhyce Kerex Publisher
Jacob. R (2001) Alternative Methods to Examine Hospital Efficiency: DEA and Stochastic Frontier Analysis, Health Care Management Science, 4: 103:115
Johnson, R.A; Kast, J.F and Rosenweig, J.E (1964) Systems Theory and Management, Management Science 10(2): 367-384
Kao, C; Chen.L; Wang, T and Kuo.S (1995) Productivity Improvement: Efficiency Approach vs Effectiveness Approach, Omega 23(2):197-204
Kaplan.R.S (2001) Strategic Performance Measurement and Management in Non-profit Organisation, Non-profit Management and Leadershi,p 11(3):353-370
Kaplan.R.S and Norton.D.P (1992) The Balanced Scorecard: Measures that Drive Performance. Harvard Business Review 70(1):47-54, Jan-Feb
Kast, F.E and Rosenweig, J.E (1972) General Systems Theory: Application for Organisation and Management, The Academy of Management Journal 15(4):447-465
Katz, M.L and Rosen.H.S (1998) Microeconomics, 3rd edition, Boston: Irwin/McGraw-Hill Companies
Katz.D and Kahn.R.L (1966) The Social Psychology of Organisations, New York: John Wiley & Sons
Khemani.S (2004) Local Government Accountability for Services Delivery in Nigeria:
Washington D.C: World Bank
Kirchoff.J.J (1997) Public Services in Production in Context: Towards a Multi-Level Multi- Stakeholder Model, Public Productivity and Management Review 21:70-85
Kirigia, J.M,Sambo,L.G and Scheel,H(2001) Technical Efficiency of Public Clinics in Kwazulu-Natal Province of South Africa, East African Medical Journal 78(3):1-13 Kirigia,J.M; Preker,A Carrin G, Mwikisa, C and Diarra-Nam,A.J(2006) An Overview of
Health Financing Pattern and the Way Forward in WHO Africa Region, East African Medical Journal, 83(9):1-28
Kirigia, J.M, Emrouznejad.A, Sambo.L.G Munguti,N and Liambila,W(2004) Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centres in Kenya, Journal of Medical Systems 28(2):155-166
Kirigia.J.M and Okorosobo,T (2005), Health Facility Efficiency Analysis, WHO/AFRO Health Economics Capacity Strengthening Workshop, Harare, Zimbabwe May, 2000
Kirigia.J.M; Emrouznejad.A and Sambo.L.G (2002) Measurement of Technical Efficiency of Public Hospitals in Kenya Using Data Envelopment Analysis, Journal of Medical Systems, 26(1): 39-45
Kirigia.J.M; Emrouznejad.A; Cassoma.B; Asbu.E.Z and Barry.S (2008) A Performance Assessment Method for Hospitals: The Case of Municipal Hospitals in Angola, Journal of Medical System 32(6):509-19
Kirigia.J.M; Sambo, L.G; Scheal.H (2001) Technical Efficiency of Public Clinics in Kwazulu-Natal Province of South Africa, East Africa Medical Journal, 78(3): S1-113
Kontodimopolous, N; Moschovakis, G; Aletras, V and Niakas, D. (2007) The Effect of Environmental Factor on Technical Efficiency and Scale Efficiency of Primary Health Care Providers in Greece. Cost Effectiveness and Resource Allocation 5(14)
Kontodimopoulous, N; Nanos, P, and Niakas, D. (2006), Balancing Efficiency of Health Services and Equity of Access in Remote Areas in Greece, Health Policy.70 (1)
Kooreman, P (1994) Nursing Home Care in the Netherlands: A Nonparametric Efficiency Analysis, Journal of Health Economics, 13 (3): 301-306
Kwakeye, E (2004) Relative Efficiency of Some Selected Hospitals in Accra-Tema Metropolis in Emrouznejad.A; Pedinovki, V (Eds) DEA and Performance Management
Labiran, A; Mafe. M;Onajola, B and Lambo, E (2008) Health Workforce Country Profile for Nigeria Observatory, Abuja Africa Health Workforce.
www.afro.who.int/hrhobservatory/country_information/countryprofiles/Nigeria_HRH _country_Profile_2008.pdf accessed 20/07/2009
Lambo, E (1989) Health for All Nigerians: Some Revolutionary Management Dimensions, University of Ilorin 36th Inaugural Lecture
Light, P.C (2000) Making Non-profit Work: A Report on the Tides of Non-profit Management reform, Washinghton: Aspen Institute and Brookings Institute
Lincoln.Y.S and Guba.E.G (1985) Naturalistic Inquiry, Beverly Hills: Sage publications Linna M. (1998) Measuring Hospital Cost Efficiency with Panel Data Models, Health
Economics, 7(5) 415-427
Linna, M; Nordbald, A and Koivu, M. (2003), Technical and Cost Efficiency of Oral Health Care Provision in Finish Health Centres Social Science and Medicine, 56. (2)
Lo, J. C.; Shih, K. S. and Chen, K. L. (1996). Technical Efficiency of the General Hospitals in Taiwan: An Application of Data Envelopment Analysis, Academic
Economics Papers. 24(3)
Luoma, K, Jarrio, M.L, Suonienu, I and Hjerppe, R.T(1996) Financial Incentives and Productive Efficiency in Finnish Health Centres, Health Economics 5(5):435- 445
Mackee.M and Henley, S (2000) The Role of Hospitals in a Changing Environment, Bull World Health Organisation, 78:803-810
Mackenbach, J.P (1991) Health Care Expenditure and Mortality from Amenable Conditions in the European Community, Health Policy, 19:245-255
Magnusen.J (1996) Efficiency Measurement and the Operationalization of Hospital Production, Health Services Research, 31:21-37
Manhiem, L.M, Feinglass, J, Shortell, S.M and Hughes, E.F (1992) Regional Variations in Medicare Hoapital Mortality, Inquiry, 29(1):55-65
Masiye,F; Kirigia J.M; Emouznejad A; sanibo, G.l ;Mounkaila A; chiwfwembe.D and okello.D(2006) Efficient Management of Health Centres Human Resources In Zambia, Journal of Medical System, 3(6) 473-481
Masiye.F (2007) Investigating Health System Performance: An Application of DEA to Zambia Hospitals. BMC Health Services Research 7(58) http://www.biomedcentral.com/1472-6963/7/58 accessed 29/10/2009
Masiye.F; Kirigia, J.M; Emrouznejad, A; Sambo.L.G; Mounkaila, A; Chimfwembe, D and Okello.D (2006) Efficient management of Health Centres human resources in Zambia, Journal of Medical Systems 30(6): 473-81
Maurrase.D.J (2002) Higher Education-Community Partnerships: Assessing Progress in the Field, Non-profit and Voluntary Sector Quarterly, 31(1)
Mckee, M and Healy .J (2002) Hospitals in a Changing Europe, Piladephia: Open University Press
Medina-Borja.A and Triantis.K (2001) A Methodology to Evaluate Outcome Performance in Social Services and Government Agencies, ASQ’s Annual Quality Congress Proceedings, Milwankee: 707-719
Mobley, L.R and Magnussen, J (1998) An International Comparison of Hospital Efficiency: Does Institutional Environment Matters? Applied Economics, 30 (8):1089-1100
Mooney G.H (1986) Economics, Medicine and Healthcare, New York: Harvester Wheatsheaf
Morse.J.M (1989) Qualitative Nursing Research: A Contemporary Dialogue, Newberry Park: Sage publication
Muhlemann, A; Oakland, J and Lockyer.K (1992) Production and Operations Management, 6th edition, Essex: Pearson Education Limited
Murray. C J. L and Frank, J (1999) A WHO Framework for Health System Performance Assessment, Global Programme on Evidence for Health Policy Decisions, paper no. 6, Geneva: WHO
Musgrove, P (1996) Public and Private Roles in Health Theory and Financing Patterns, Washinghton.D.C: The World Bank discussion paper no.339
Mwase, T. (2006), The Application of National Health Accounts to Hospital Efficiency, Analysis in Eastern and South Africa USAID (www.PHRplus.org)
Nahmias.S (2005) Production and Operations Analysis, 5th edition, New York: McGraw- Hill Companies Inc
Nguyen.K.M and Long.G.T (2004) Efficiency Performance of Hospitals and Medical Centres in Vietnam.Munich Personal REPEC MPRA archieve paper no.1533
Nolan.T, Angos,P, Cunha,A. J, Muhe,L, Quazi,S, Simues, E.A, Tamburlini,G,Weber,Mand Pierce, N.F(2001) Quality of Hospital Care for the Seriously ill Children in less Developed Countries, Lancet 357(9250):106-110
Norman, M and Stocker, B (1991), Data Envelopment Analysis: The Assessment of Performance. Chichester: John Wiley & sons
Nwabobi, G. Modelling the Health Sectior in Nigeria.
http://129.3.20.41/eps/pe/papers/0509/0509508.pdf accessed on August 15, 2008 Nwase T. (2006) The Application of National Health Account to Hospital Efficiency
Analysis in Eastern and South Africa. USAID (www.PHRplus.org
Nyman, J.A; Bricker, D.L and Link, D (1990) Technical Efficiency in Nursing Homes, Medical Care, 28:541
Ogun State Ministry of Health (2006) Ogun State Health Bulletin 3
Ogunbekun A Orobaton.N (1999) Private Health Care in Nigeria: Walking the Tight Rope;
Health Policy & Planning, 14(2):174-181
Osei, D. d’Almeida, S.; George, M. O.; Kirigia, J. M. and Kainyu, L. H. (2005). Technical Efficiency of Public Hospitals and Health Centres in Ghana: A Pilot Study. Cost Effectiveness and Resource Allocation, 3(9)
www.reource-allocation.com/content3/1/9 accessed 29/10/2009
Otokiti.S.O (2005) Methodologies and Mechanics of Computational System, New Delhi:
Sultan Chand and Sons Publishers
Owino.W and Korir.J (1997) Public Health Sector Efficiency in Kenya: Estimation and Policy Implications, Kenya Institute of Policy Analysis and Research
Ozcan Y.A and Luke, D (1993) A National Study of the Efficiency of Hospitals in Urban Markets, Health Services Research 27(6): 45-77
Ozcan, Y.A, Luke, R.D and Haksever, C (1992) Ownership and Organizational Performance:
A Comparison of Technical Efficiency across Hospital Types, Medical Care, 30(9):781-794
Ozcan.Y and Bannick.R.R (1994) Trends in Department of Defense Hospital Efficiency, Journal of Medical System, 18:69-83
Ozigbo, N.C (2002) Production Management: Concepts and Cases, Enugu: Precision Publishers Limited
Parkin, D. and Hollingsworth, B. (1997), Measuring Production Efficiency of Acute Hospitals in Scotland, 1991 – 1994: Validity Issues in Data Envelopment Analysis, Applied Economies. 29(11)
Pasupathy, K.S (2002) Modelling Undesirable Output in DEA: Various Approaches.
Unpublished M.Sc Thesis, Virgina polytechnic institute and State University
Pauly.M.V (1987) Non-profit Firms in Medical Markets, The American Economic Review, 77:257-262
Peacock, S,Chan, C, Mangolini, M and Johansen, D (2001)Techniques for Measuring Efficiency in Health Care Services, Canberra:Productivity Commission Working Paper
Pedraja-Chaparro.F; Salinas-Jimez.J and Smith.P.C (1999) On the Quality of DEA Model, Journal of Operations Research Society 50(6):636-644
Pehnelt, G( n.d) Efficiency Measurement in Health Care, European Centre for International Political Economy, http://www.ecipe.org/files/efficience
Perlman. S and Prestieau, P (1988) Technical Performance in Public Enterprises: A Comparative Study of Railways and Postal Services, European Economic Review 32(2&3): 432-441
Pindyck, R.S and Daniel, L.R (2005) Micro economics, New Jersey: Pearson Education Inc Pope.C and Mays.N (2000) Qualitative Research in Health Care, London: BMJ books